Thematic analysis of a suicide note revealing a possible and undiagnosed dissociative identity disorder: a case report

This study analysed a suicide case involving a potential dissociative identity disorder (DID) through the analysis of a suicide note and two additional handwritten notes. These were found during the death scene investigation of a hanging case of a woman as part of the judicial investigation, including autopsy and toxicological examination. Each of the notes was preceded by the name of the deceased, followed by a number (for example, Giulia 1 and Giulia 2; fictional names). It was reported in the deceased’s clinical history the presence of unidentified psychological disorders. We employed a discourse analysis of these texts. Eight main themes emerged from the in-depth analysis, expressing the possibility of a DID. The themes were divided into Giulia 1 (who wants to live) and Giulia 2 (who wants to commit suicide). Our study highlights the complexity of suicidal behaviour in patients with DID, underscoring the relevance of early diagnosis and treatment to prevent suicide. Suicidal notes, which are relevant for forensic investigation, may also be useful for clinical aims, including the development of preventive strategies to reduce suicide rates among this population.